RH Reality Check » newborn healthhttp://rhrealitycheck.org
News, commentary and analysis for reproductive and sexual health and justice.Tue, 31 Mar 2015 21:24:03 +0000en-UShourly1http://wordpress.org/?v=4.1.1What Happens to Washington State Women if Title X Falls?http://rhrealitycheck.org/article/2011/02/14/draft-title-x/?utm_source=rss&utm_medium=rss&utm_campaign=draft-title-x
http://rhrealitycheck.org/article/2011/02/14/draft-title-x/#commentsMon, 14 Feb 2011 22:16:06 +0000If the GOP push to eliminate Title X is successful, along with their attempts to defund Planned Parenthood, low income Americans in need of family planning services in states like Washington State will have nowhere to go.

“It is my view that no American woman should be denied access to family planning assistance because of her economic condition. I believe, therefore that we should establish as a national goal the provision of adequate family planning services within the next five years to all those who want them but cannot afford them. This we have the capacity to do.”

– President Richard Nixon, 1970

We need to make population and family planning household words. We need to take sensationalism out of this topic so that it can no longer be used by militants who have no real knowledge of the voluntary nature of the program but, rather are using it as a political steppingstone. If family planning is anything, it is a public health matter.”

“What is more fiscally responsible than denying any and all funding to Planned Parenthood of America?” demanded Representative Mike Pence of Indiana, the chief sponsor of a bill to bar the government from directing any money to any organization that provides abortion services.

You’d think Rep. Mike Pence’s (R-IN) bill to defund Planned Parenthood, an organization which provides preventive health care to millions of Americans around the country, would be enough of a blow. They are going for the deep, painful cuts leaving many millions of Americans who are already at their most vulnerable even more exposed with a House leadership budget proposal to completely eliminate Title X, one of the most successful federal safety net programs this country has ever seen. It’s not a political game, as much as Live Action hoax video-makers Lila Rose and James O’Keefe seem to think it is. As states grapple with similar budget cutting, our friends, family and community members will find themselves without basic healthcare and as tax-payers we’ll literally pay the price of the decimation of a crucial public health safety net. In Washington State, with a multi-billion dollar budget shortfall, residents are already bracing for the impact of state cuts to family planning, maternity health services, health insurance for lower-income residents, prescription drug benefits for seniors and more. The elimination of the federal Title X program would be disastrous.

This may feel like a swipe out of nowhere but it’s been a long time in the making for the GOP. An extremely well-funded, coordinated attack has been waged and despite what it may be portrayed as in the mainstream media, this is far from only an attack on Planned Parenthood. This is an attack on millions of Americans. Title X does contribute towards the 97 percent of Planned Parenthood’s health care services which are preventative: annual exams, HIV testing, family planning, birth control, STI testing and treatment. However it also helps to fund public health centers around this country – health centers which are often the only sources of health care for our country’s lower-income women, men and children. On a conference call with the press, Senate Democrats spoke of these proposed cuts, as well as the legislative attacks in the form of HR 3 and HR 358, as the most comprehensive threat to women’s health in our lifetime.

Senator Blumenthal called it:

“an unprecedented assault on women’s health….It creates reprehensible risks for the health of countless women across the country, puts them in jeopardy of losing vital health services, and it imperils not just them, but their families.”

In Washington State, the public health clinics around the state served by our country’s Title X program provide care to a majority of the state’s uninsured population. Sixty percent of the clients of the Public Health Department’s family planning clinics have no insurance; not even Medicaid. Another 25 percent use Medicaid as insurance coverage and the rest utilize Take Charge.

“These proposed federal cuts would wipe out family planning services for thousands of low income and uninsured women who visit our Public Health Centers across King County, piling on top of new and devastating state cuts to family planning and other Medicaid-supported services.”

We’re talking about women, men and young people who use family planning clinics, in particular, as a primary source of care throughout the state. Title X helps to fund family planning clinics that cover a broad range of services. According to PHSKC, for 3 out of every 4 poor women, family planning clinical services comprise their usual source of health care; especially when it comes to African-American or Latina women, uninsured people or those born outside of the United States. According to Dana Laurent, Political Director for Planned Parenthood Votes! WA, 60 percent of Planned Parenthood patients in Washington State utilize Planned Parenthood for their primary health care.

In addition, adds Laurent, 65 percent of their contraceptive clients rely on Title X to fund their care:

“Our Title X clients are not just receiving contraception, they receive breast exams, pap smears for early detection of cervical cancer, high blood pressure screenings – these women depend upon Title X for basic health care.”

And though Planned Parenthood provides services using Title X funds, they cannot afford to do so for free or on a sliding scale, the way family planning public health clinics do. City and state public health departments rely heavily on a variety of funding sources in the absence of other forms of revenue like fundraising and substantial client payments.

In King County for example, the Public Health Department for Seattle-King County is the only Title X provider for STD services. Title X programs do not need to cover STI services but King County does so anyway. The state is facing an STD crisis of immense proportions and more providers are unable to offer services to clients who are unable to pay. When a client visits a health care provider for care and he or she cannot afford the STD fees (upwards of $300 to $400), they are referred to Public Health. The Guttmacher Institute found that one in three women who received HIV testing or other STI testing did so at a publicly funded family planning center. Where do we think women, men and young people will go when their very last option is taken from them?

Says Laurent:

“They won’t have anywhere to go. We serve 140,000 patients around Washington State each year. The impact of eliminating Title X would be devastating to women’s health.”

The economic impact of eliminating Title X, on top of harsh state budget cuts, would reverberate for years and, in fact, add to federal, state and local public health costs. Nationally, for every 1000 women who lose access to publicly-funded family planning, 25 percent will become pregnant within the first year. In Washington State, for every $1 spent on family planning for lower income Americans, we save over $4 in Medicaid-covered pregnancy-related care.

Apa says:

“Cutting proven health-promoting and cost-saving programs for our most vulnerable women makes no sense, particularly when such cuts would lead to thousands of additional unintended pregnancies each year.”

Laurent agrees:

“There are tens of thousands of women in Washington State who, if Title X funding is eliminated, will have virtually nowhere else to go. Our state’s public health safety net is really crumbling because of our state budget crisis and the percentage of our public health partners able to offer family planning services have dwindled. Planned Parenthood has tried to pick up those pieces even though our budget has been cut.”

Some of those partners – like Maternity Support Services in the state, for example – are being hit hard as well. If family planning access dwindles, women who need public funding for pregnancy and birth related care will increase. According to the Public Health Department, one in three women giving birth in Washington receives Maternity Support Services. However, what happens to those women who can no longer receive support from the program? Without the ability to access safe prenatal and childbirth care, plan for pregnancy and birth, and space out pregnancies, our poorest and most vulnerable women become that much more vulnerable to life and health threatening conditions. As well, we’re placing newborn’s health and lives in danger. Washington State residents – and taxpayers across the country – will pay for the Republican-proposed budget cut to Title X – not only in increased costs related to emergency care and unintended pregnancy – but with the health and lives of our women and babies.

And Laurent says Planned Parenthood is shocked for other reasons as well.

“This was a Congress that came in saying they’d fix the economy and create jobs and instead they’ve launched an attack on women under guise of deficit reduction when we all know the opposite is true – family planning saves money. This attack is not solution oriented. But we are making a loud and powerful noise and we are absolutely going to send a message to the extreme leadership: They need to stop the assault on women’s health!”

Title X is the only federal program with guidelines that ensure that no one can be turned away from accessing family planning services, because of inability to pay. In Washington State, as is the case around the country, the funding for family planning is thrown together a bit like those dinners you make from whatever’s left in the fridge; a sprinkling of something here, a dash of something else there. Each piece, though, is critical to ensure that family planning access remains intact for our most at-risk residents. Title X has been an extraordinarily effective program created as a public health tool to help provide care for millions of Americans over the last forty years. Though the GOP has turned the public health program into an ideological and political game on the federal level, the consequences of cutting it for communities around the country are very real.

]]>http://rhrealitycheck.org/article/2011/02/14/draft-title-x/feed/2Dutch Study Pumps Exclusive Breastfeeding, Support Still Lackinghttp://rhrealitycheck.org/article/2010/07/21/breastfeeding-news/?utm_source=rss&utm_medium=rss&utm_campaign=breastfeeding-news
http://rhrealitycheck.org/article/2010/07/21/breastfeeding-news/#commentsWed, 21 Jul 2010 14:30:00 +0000Dutch researchers find prolonged and extended (and exclusive) breastfeeding significantly reduces the risk of infectious diseases in infants, confirming what we've known for a long time: breast is best, if only society would actually prioritize the support women and babies need to ensure it happens.

]]>I write, occasionally, about breastfeeding and bottlefeeding. I try, when I do, to present a balanced approach. It is challenging at times – to reconcile the choices I’ve made personally with my own children, with evidence-based studies and information that seems to come out regularly pointing to the overwhelming health benefits of exclusive breastfeeding; with the anger and frustration some women share over their own guilt about not breastfeeding their children; or the frustration they feel that they are made to feel guilty about the choices they’ve made. It’s a fine line one walks between presenting the information and making mothers feel guilty for the loving and thoughtful choices we make on behalf of our children. At the very least, it’s hard to deny that regardless of whether new mothers chose, in this country at least, to breastfeed or formula feed or do a combination of both, or if the choice is made for us because of HIV status, or because of low milk-supply for example, we will be judged in some way. It is, on the other hand, possibly helpful to suggest that women can be stronger than we sometimes give ourselves credit for (barring postpartum mood disorders which can leave women without the full ability to control one’s reaction to situations and experiences); that we can learn to stand up to judgment, to speak up against criticism, bias and outright prejudice from those who disagree with our choices (or lack thereof).

I begin this post with this sort of olive branch to all new mothers because, while I formula fed one of my children from the time he was a newborn, and breastfed my other until she was three years old (and would have gone longer had she not fallen quite ill), I want to continue to share positive, solid evidence that supports how important – and truly amazing – breastfeeding can be to a healthy start in life, if it’s a feasible option for you and your baby.

With that in mind, I offer up the results of a study completed by Dutch researchers and released last month, published in the journal Pediatrics, of the American Academy of Pediatrics, on the importance of exclusive breastfeeding for babies up to 6 months old and partially for babies up to twelve months old.

The study, undertaken in the Netherlands, showed that babies who were partially breastfed for at least four months had markedly lower incidents of upper and lower respiratory infections as well as severe gastrointestinal issues as well. Breastfeeding had such a significant impact, in fact, that the researchers found that:

Exclusive breastfeeding until the age of 4 months and partiallythereafter was associated with a significant reduction of respiratoryand gastrointestinal morbidity in infants.

In other words, it is literally saving babies’ lives in some instances. Please understand that, as a first time mother who did not breastfed her baby, this information is not meant to scare new mothers – though I realize it might do that for some. It’s meant to help us all understand how important it is to persuade our health providers, policymakers and business owners that we must implement mother-and-baby friendly policies in order to protect the health and lives of our newborns.

Miriam Labbock, MD, MPH, a professor at the University of North Carolina, Chapel Hill and the Director of the Carolina Global Breastfeeding Institute told me that the results of this new study were not surprising to her. Earlier studies have shown the same thing.

In 2006, the journal Pediatrics published a study which found that exclusive breastfeeding for at least six months or more place a baby at a signicantly decreased risk for pneumonia, than those babies who were exclusively breastfed for four to six months.

In 1987, Lancet published a study out of Brazil which found similar marked impacts of breastfeeding on gastrointestinal and respiratory infections, resulting in death in some instances:

“Ever since we started studying the difference between exclusive and partial breastfeeding, we have seen this unexpected slight increase in lung issues with early partial breastfeeding. Why, you might ask? I could postulate that even some formula use ends up with increased microbuli to the lungs, promoting infection. This is compounded by the fact that we see that partially breastfed infants are more likely to be in day care where they are exposed to more infections and we might guess that the anti-inflammatory impact of breastfeeding is muted, so that we see the symptoms more.

All in all, it just keeps showing up – not for diarrhea, where any intensity of breastfeeding helps, but for lung issues.

Since pneumonia is the major cause for hospitalization in the the first year of life in North Carolina, this is yet another reason that we must work for exclusive breastfeeding, not partial, not expressed milk feeding, but exclusive breastfeeding for at least the early weeks and months.”

These are studies that, taken together over years and years, make you wonder why we are not, as a nation, prioritizing hospital and workplace policies, and laws that make breastfeeding as normal, and relatively easy to continue for an extended period of time, as possible. If the health benefits of breastfeeding are so acute, so great, why wouldn’t those extremely vocal, angry anti-choice organizaions which work so long and hard to wrest rights away from women and physicians in the name of “life”, work equally as hard to ensure a healthy life for babies and mothers? Universal health care for all – let no newborn go without health care. Ensure all pregnant women and new mothers have access to high quality health care including postpartum care, lactation services and more. Maternity leave, for all jobs, should be a national priority. Why don’t all working women, who are new mothers, automatically have nursing breaks as part of their back-to-work schedule? Why aren’t all hospitals baby-friendly hospitals, focusing first and foremost on providing all the information, resources and support a woman needs to exculsively breastfeed for the first few months?

Information on the health benefits of breastfeeding is important to highlight in order to help pregnant women come to a thoughtful decision about how they are going to feed their babies but for too many new mothers, it’s the lack of societal support and an absence of prioritization on the national level which is the real decision-maker.

]]>http://rhrealitycheck.org/article/2010/07/21/breastfeeding-news/feed/0At G8 and G20, the Streets are Empty: Let’s Hope the Promises Won’t Behttp://rhrealitycheck.org/article/2010/06/25/streets-empty-lets-hope-promises-wont/?utm_source=rss&utm_medium=rss&utm_campaign=streets-empty-lets-hope-promises-wont
http://rhrealitycheck.org/article/2010/06/25/streets-empty-lets-hope-promises-wont/#commentsFri, 25 Jun 2010 13:52:48 +0000The G8 must commit new resources for maternal, newborn and child health, including all reproductive health services. Integrated sexual and reproductive health services have been proven to be cost-effective and to save lives.

]]>I arrived in Toronto yesterday to cover the G8 and G20 Summits with civil society representatives from around the world. The streets of downtown Toronto are empty-the locals have fled, businesses have closed and boarded up their windows, employees are working from home, and my taxi driver told me he waited three hours to pick up a fare. There are police on most corners, more arriving in buses and motorcades, and fences have been erected around the area. The world leaders are arriving, but are out of sight.

Those of us representing civil society groups have been assigned to work in the “Alternative Media Center” which is across the street from The International Media Center, the “real” media center, separated by a busy street, more high fences, and concrete barricades. This means we have little or no access to international media outlets. Many of us who are activists and advocates pride ourselves on being a bit alternative, but in this case the Alternative Media Center is the Canadian government’s inelegant solution to concerns that civil society representatives from a broad range of issues would generate negative media coverage of G8 and G20 and their failure to meet past commitments. We are receiving the live news feed from the G8 meeting but there are no speakers so we are huddling around the televisions-the leaders need to speak up, literally and figuratively. Apparently this isn’t the norm. “NGOs are profoundly disappointed with the tone the Canadian government has set by barring NGOs and civil society from the international media center for the first time in recent history,” wrote David Olson on Blog 4 Global Health. “In both L’Aquila, Italy and Pittsburgh last year, NGOs and media shared the same media center in a way that was mutually beneficial for both parties.”

Will the situation in the streets and where we work prove to be a metaphor for the next few days? Civil society is here but we don’t have a place at the G8 or G20 table and are limited in our ability to carry the demands of the world’s poor to the world leaders, and to the media. The world leaders are here but will they hide from the commitments they made to health at the Gleneagles Summit in 2005 and from making concrete new commitments to save the lives of women and children and address poverty globally? Will the G8 leaders commit to accountability mechanisms that are as strong as armed guards and high fences outside? A mechanism that would allow us to track progress on G8 commitments and to hold governments to actually fulfilling the promises they make?

Everyone is watching and waiting in the city today, wondering if there will be violence or if there will be Head of State sightings as motorcades roll past. Similarly, we are watching and waiting to learn what the G8 governments will commit to do to address the signature initiative of this G8, The Muskoka Initiative for maternal and child Health. The G8 must make a collective commitment to new resources for maternal, newborn and child health including reproductive health. This commitment must include access to integrated and cost-effective interventions which have been proven to save lives. It is time for the G8 to ensure that every pregnancy is wanted, every birth is safe, and every newborn and child is healthy. This morning, the Alternative Media Center was evacuated due to a bomb scare. I hope that means that some groups realize the voices in this building do have power, and that we will continue working to make our voices ant he voices of all of those we represent heard. We also hear the streets won’t be empty for long. Let’s hope that as the protestors flood the streets tomorrow, the G8 and G20 leaders will unleash a similarly powerful flow of real commitments to saving the lives of women and children. Soon the streets won’t be empty, and the promises must not be either.

]]>http://rhrealitycheck.org/article/2010/06/25/streets-empty-lets-hope-promises-wont/feed/0The Best and the Worst Places To Be A Momhttp://rhrealitycheck.org/article/2010/05/26/best-worst-places/?utm_source=rss&utm_medium=rss&utm_campaign=best-worst-places
http://rhrealitycheck.org/article/2010/05/26/best-worst-places/#commentsWed, 26 May 2010 15:50:57 +0000A new report produced by Save the Children ranks the best - and the worst- places to be a mother around the world.

]]>Despite global maternal health agreements, which promise huge returns; and a renewed focus of late on the critical importance (did I really need to write that?) of investing in improving maternal health outcomes in this country, the United States still ranks 28th of 160 countries when it comes to the best and worst places to be a new mother around the world, according to a report released by Save the Children this month.

The United States did not fare well; it was 28th, below Greece, Portugal and virtually all of Western Europe. It ranked just above Poland and most of the former Soviet bloc.

I imagine, already, those commenters and committed conservative voices clinging to the idea that somehow a ranking of 28th in the world is not that bad, that it’s women’s fault, that it’s the fault of a bloated court system allowing for too many malpractice suits which scare doctors and hospitals or my favorite – it’s because of access to legal abortion. But the reality is that the U.S. health care system, a system in which more money is spent per capita then any other in the industrialized world, is failing our mothers and newborns. How does this happen? Notes the NYT article:

The chief reason for the low American ranking, the authors said, was that despite advanced medical technology, more young mothers die, either in childbirth or in the years after, than in most rich countries. The United States also lost points because American working mothers get less maternity leave and lower benefits.

The thing is, while preventing as many deaths of mothers during or after childbirth and creating an optimal environment for new mothers to parent are crucial and worthy goals in and of themselves, the state of mothers’ lives has an immense effect on the health and lives of newborns, babies and families in the U.S. as well.

From a post I wrote a couple of months ago on the connection between breastfeeding rates in the United States and ensuring important rights for women like paid family leave, access to high quality health care and more,

Even though we spend more, per capita, every year on health care, we rank 37th in infant mortality in the world. According to Momsrising.org, when paid family leave is instituted we see a 25 percent drop in infant mortality rates. One of the reasons? It allows mothers the time to establish a breastfeeding relationship with their new baby.

As Kristin Rowe-Finkbeiner, founder and executive director of Momsrising.org told me this year,

The U.S. “stands out like a sore thumb with our lack of paid family leave”, says Rowe Finkbeiner. “Of over 170 countries, only four don’t have some form of paid family leave for new mothers: Papua New Guinea, Swaziland, Liberia and the U.S.”

And while it’s true that paid family leave is important, even more basic in poorer countries, notes the New York Times article, is the availability of a skilled female birth attendant – in particular a midwife, in countries like Afghanistan which was rated the worst place in the world to be a mother:

The most important factor in how mothers and babies fared in very poor countries was whether or not a female health worker helped at the birth. Since many men refuse to let their wives be seen by male doctors and many grandmothers give dangerous traditional advice, trained midwives can save lives, the authors said. After Afghanistan, the worst countries were Niger, Chad, Guinea-Bissau, Yemen, the Democratic Republic of Congo, Mali and Sudan; many are conservative Muslim countries where education for girls is discouraged.

How exactly do “pro-life” advocates square their stance that by blocking access to safe and legal abortion services in this country, while standing around and doing nothing to address war-torn (by the United States) Afghanistan’s dismal maternal mortality rates or addressing the circumstances in the U.S. which lead to the loss of womens’ and newborns’ lives at unforgivable rates, they are actually improving people’s lives? It’s hard to know, exactly. It’s hard to know because searching for maternal health advocacy efforts from any larger anti-choice organization yields pretty much nothing except the same virulent anti-abortion messaging for which they are known. Go ahead, try googling “pro-life maternal health” and see what you come up with. If you come up with anything at all unrelated to abortion, please let me know.

Yet, here we stand in 2010, a report from the organization Save the Children in hand, letting us know that if you want to be treated with the respect, dignity and care you deserve, as a new mother, your best bet is to reside in Norway; and that your life is in danger should you reside in so many countries around the world from Niger to Afghanistan to Sierra Leone.

Is it an accident that the country rated safest for new mothers – Norway – is a country whose abortion laws are relatively liberal – with abortion allowed in the first and second trimesters and in the third, only under special circumstances? Of course not. Is it a coincidence that, according to the report, in the countries with the highest maternal mortality rates like Afghanistan, Angola, Chad and Niger, women’s status is abysmal, with women receiving less than four or five years of educaton in total?

Maternal health around the world is dependent upon the tenet that women must have the right to decide, for themselves or in concert with a health professional, what is best for their health and lives. Without access to health care from the most basic care to contraception, prenatal care, legal abortion, skilled birth attendants, postpartum resources, paid family leave, adequate education and more we allow for the conditions that keep women oppressed and we put women’s health and lives at risk, plain and simple.

Is it surprising that those countries in which women’s health and lives are routinely compromised are some of the poorest in the world? The temptation might be to say that these are the countries that cannot afford to invest in such complete overhauls of the system. But, of course, we know that when we raise the status of women and girls in a country, we improve the lives of children, families and in fact improve the economic status of a region as well. Are we so terrified of the true power of women and girls around the world, then, that we are willing to sarifice their lives? The number of reports are stacking up – we know where women’s health and lives stand around the world. Now, what are we going to do about it?

]]>http://rhrealitycheck.org/article/2010/05/26/best-worst-places/feed/0Expanded Support for Midwifery Services a Win-Win in Health Reformhttp://rhrealitycheck.org/article/2010/03/24/expanded-support-midwifery-serviceswinwin-health-reform/?utm_source=rss&utm_medium=rss&utm_campaign=expanded-support-midwifery-serviceswinwin-health-reform
http://rhrealitycheck.org/article/2010/03/24/expanded-support-midwifery-serviceswinwin-health-reform/#commentsWed, 24 Mar 2010 09:01:00 +0000As an addendum to yesterday's a broad-brush overview of the implications for women of the health reform, here is an overview of how the bill addresses midwifery provided by certified nurse-midwives and expands the conditions under which nurse-midwives may provide broader health care services.

]]>Yesterday we provided a broad-brush overview of the implications for women of the health reform bill signed into law yesterday by President Obama.

At the time, it was not yet clear which elements of the original House bill favorable to expansion of midwifery services provided by certified nurse-midwives had survived and been incorporated into the Senate bill ultimately passed by the House this weekend.

As an update to our original article–and because midwifery services have been a long-neglected and in fact marginalized aspect of health care for women–here is an overview of how the bill addresses midwifery provided by certified nurse-midwives and expands the conditions under which nurse-midwives may provide broader health care services.

The American College of Nurse-Midwives underscores that certified nurse-midwives (CNMs) and Certified Midwives (CMs) provide health care services to women of all ages and stand to play a vital role in increasing access to quality, affordable primary care, gynecology, family planning, and maternity care services. Toward this end, the bill does the following:

Expands services:

Equitable reimbursement of midwives under Medicare. The bill establishes reimbursement for CNMs at 100 percent of the Part B fee schedule as of January 2011, equivalent to physicians. “Inadequate reimbursement for midwifery services has been a significant barrier to women’s access to the valuable services of CNMs and certified midwives (CMs),” stated ACNM President Melissa Avery, CNM, PhD, FACNM, FAAN. “This legislation not only improves Medicare for women, but will encourage Medicaid plans and third-party payers to adopt equitable reimbursement policies for midwifery services.”

According to ACNM:

Equitable reimbursement will enhance the viability of midwifery practices as well as increase the incentive for hospital and physician practices to employ CNMs and CMs. In addition, CNM- and CM-attended births—which occur primarily in hospitals, but also in birth centers and private residences—are associated with high-quality outcomes and fewer cesarean sections. The US cesarean section rate has reached an all-time high of nearly 1 in 3 births; cesarean section has been identified as an overused maternity care intervention by the National Priorities Partnership, an influential multi-stakeholder coalition working to identify top priorities for improving the quality and affordability of health care in the US.

Expands options for nurse-midwives in home health care. The bill clarifies that the face-to-face encounter required prior to certification for home health services may be performed by a physician, nurse practitioner, clinical nurse specialist, certified nurse-midwife, or physician assistant.

Maternal, Infant, and Early Childhood Home Visiting Programs. Provides funding to States, tribes, and territories to develop and implement one or more evidence-based Maternal, Infant, and Early Childhood Visitation models. Model options would be targeted at reducing infant and maternal mortality and its related causes by producing improvements in prenatal, maternal, and newborn health, child health and development, parenting skills, school readiness, juvenile delinquency, and family economic self-sufficiency. This is particularly critical for low-income women.

Support, Education, and Research for Postpartum Depression. Provides support services to women suffering from postpartum depression and psychosis and also helps educate mothers and their families about these conditions. Provides support for research into the causes, diagnoses, and treatments for postpartum depression and psychosis.

Patient Protections. Requires that a plan enrollee be allowed to select their primary care provider, or pediatrician in the case of a child, from any available participating primary care provider. Precludes the need for prior authorization or increased cost-sharing for emergency services, whether provided by in-network or out-of-network providers. Plans are precluded from requiring authorization or referral by the plan for a female patient who seeks coverage for obstetrical or gynecological care.

Taken together, these provisions greatly expand both the range of options available for care and the degree of choice individuals can exercise in choosing primary care-givers without facing undue barriers and approvals from insurance companies.

Expands the pool of primary caregivers.

The health reform bill also helps to strengthen the pool of primary caregivers in a variety of ways, including through expanded support for the education and training of nurses and nurse-midwives.

Advanced Nursing Education Grants. Strengthens language for accredited nurse-midwifery programs to receive advanced nurse education grants in Title VIII of the Public Health Service Act.

Expands the pool of nurses through education grants. A nursing Loan Repayment and Scholarship Program will provide for additional faculty at nursing schools as eligible individuals for loan repayment and scholarship programs and establishes a Nurse Faculty Loan Program for nurses with outstanding debt who pursue careers in nurse education. Nurses agree to teach at an accredited school of nursing for at least 4 years within a 6-year period.

Graduate Nurse Education Demonstration Program. This provision directs the Secretary to establish a demonstration program to increase advanced practice nurse education training under Medicare and authorizes $50 million to be appropriated from the Medicare Hospital Insurance Trust Fund for each of the fiscal years 2012 through 2015 for such purpose.

In short, states ACNM, this is a critical step toward eliminating health disparities and improving health care access for the millions of women who are currently uninsured.

In addition to equitable reimbursement for midwives, the bill recognizes freestanding birth centers under Medicaid, improves access to women’s preventive health services, ensures direct access to the obstetrician/gynecologist or CNM/CM of their choice, takes significant steps to address the health care workforce needs of the nation, ends gender discrimination and exclusion based on pre-existing conditions, and begins the effort to reduce the rate of increase for medical malpractice insurance through state-focused initiatives.

]]>http://rhrealitycheck.org/article/2010/03/24/expanded-support-midwifery-serviceswinwin-health-reform/feed/2Providing Gender-Responsive Aid in Haitihttp://rhrealitycheck.org/article/2010/01/17/providing-genderresponsive-aid-haiti/?utm_source=rss&utm_medium=rss&utm_campaign=providing-genderresponsive-aid-haiti
http://rhrealitycheck.org/article/2010/01/17/providing-genderresponsive-aid-haiti/#commentsSun, 17 Jan 2010 11:00:00 +0000In Haiti, as is always true in the aftermath of a major disaster, there are urgent needs for medical care specific to women, particularly for pregnant women and mothers with new babies.

In Haiti, as is always true in the aftermath of a major disaster, in addition to the
urgent need for what we traditionally consider the pillars of immediate
aid–food, water, shelter, medical care–there are needs that are
specific to women, particularly for pregnant women and mothers with new
babies and the need to address the added vulnerability to violence that
women face when government infrastructures are dysfunctional.

(W)omen of reproductive age face limitations in
accessing pre-natal and post-natal care, as well as greater risk of
vaginal infections, pregnancy complications including spontaneous
abortion, unplanned pregnancy, and post-traumatic stress. An increase
in violence against women was also recorded…

…(I)n natural disaster situations and in post-disaster recuperation,
the cases of violence may increase. “Given the stress that this
situation caused and the life in the refuges, men attacked women more
frequently.

women suffer most from the impact of climate change and
natural disasters because of discrimination and poverty. The same
happened to women victims of Hurricane Katrina and the 2004 Indian
Ocean Tsunami as documented in a report on “Gender and Climate Change.”

Tracy Clark-Flory addresses these issues relative to providing aid in Haiti in a piece on Salon’s Broadsheet:

It isn’t just that women often require special care and
resources post-disaster; human rights organizations say that they could
also play a critical role in distributing much-needed aid. Women “are
central actors in family and community life,” says Enarson, and are
more likely to know “who in the neighborhood most needs help — where
the single mothers, women with disabilities, widows and the poorest of
the poor live.” Diana Duarte, a spokesperson for MADRE,
an international women’s rights organization that has joined the relief
effort, put it this way: “Women are often more integrated and more
aware of the vulnerabilities of their communities.”

Even beyond the initial emergency response, there lies a long road
to recovery that holds other unique challenges for women and girls.
They are “at increased risk of gender-based violence, especially
domestic violence and rape but also forced marriage at earlier ages”
due to their increased dependence on men for protection and support,
says Enarson. After a disaster of this magnitude, there will also be
scores of “newly disabled, widowed or homeless women” in need of help.
MADRE’s Duarte points out that women’s generally higher “level of
poverty negatively effects their ability to access resources to
rebuild.”

Clark-Flory also points to the work of the Gender and Disaster Network which calls for a gender-responsive approach to aid in Haiti and has a wealth of resources on the topic here.

All Haitians are suffering right now. But, women are
often hardest hit when disaster strikes because they were at a deficit
even before the catastrophe. In Haiti, and in every country, women are
the poorest and often have no safety net, leaving them most exposed to
violence, homelessness and hunger in the wake of disasters. Women are
also overwhelmingly responsible for other vulnerable people, including
infants, children, the elderly, and people who are ill or disabled.

Because of their role as caretakers and because of the
discrimination they face, women have a disproportionate need for
assistance. Yet, they are often overlooked in large-scale aid
operations. In the chaos that follows disasters, aid too often reaches
those who yell the loudest or push their way to the front of the line.
When aid is distributed through the “head of household” approach,
women-headed families may not even be recognized, and women within
male-headed families may be marginalized when aid is controlled by male
relatives.

It is not enough to ensure that women receive aid. Women in
communities must also be integral to designing and carrying out relief
efforts. When relief is distributed by women, it has the best chance of
reaching those most in need. That’s not because women are morally
superior. It is because their roles as caretakers in the community
means they know where every family lives, which households have new
babies or disabled elders, and how to reach remote communities even in
disaster conditions.

Moreover, women in the community have expertise about the specific problems women and their families face during disasters.

Unfortunately, in big relief operations, already-marginalized people are usually the ones who “fall through the cracks.

None of this sits too well with the men’s rights movement. Robert Franklin, Esq. has this to say at Men’s News Daily:

(A)ccording to Clark-Flory, ”women in general will be in
need of ‘hygiene supplies…” Men and boys apparently will not need
those things. And “women often require special care and resources post
disaster.” Men and boys don’t need those things either. Is that
because men and boys are supermen who don’t need help? Or is it
because they’re less deserving of it than are women and girls?

First of all, the piece did not say that men and boys don’t deserve
aid, it said that women have some needs that men don’t have that also
need to be addressed. Secondly (having hopefully given female readers
time to pick themselves up off the floor from laughing)–apparently Mr.
Franklin, Esq. does not go to the grocery or drug store very often or
he would know that hygiene is our oh so clean euphemism for sanitary products–oh wait, that is a euphemism too–okay, excuse my indelicacy–it means tampons and pads that women use when they MENSTRUATE
(there, I said the word). As a general rule, most of the people who use
those products are FEMALE. But if Mr. Franklin, Esq. really feels that
he needs them, I’m sure we can send him a box with explicit
instructions on where to shove them.

As for special care, unless men get pregnant and have babies, they probably do not require that assistance either.

Over at Spearhead
(they’re not subtle are they?), they also object to Gender and Disaster
Network’s “Elaine Enarson (probably a Swedish woman)” saying that,

They are “at increased risk of gender-based violence,
especially domestic violence and rape but also forced marriage at
earlier ages” due to their increased dependence on men for protection
and support.

with this,

So now when men provide women with protection and
support they are suspected rapists, child molesters and batterers? Are
these strange, foreign women more trustworthy than Haitian girls’
fathers, brothers and grandfathers? I try to refrain from inserting my
opinion when I am writing these news pieces, but Ms. Enarson is making
one of the most offensive insinuations possible with the above
statement, and she is dead wrong. It is matriarchal societies where
women cannot rely on men for support in which women face the most
danger.

Really? Name one matriarchal society where this is or was so. And
yes, women who are in general more likely to be victims of intimate
violence are far more likely to be victimized when they suddenly become
more physically vulnerable.

In the face of obstacles and the needs that have been
identified, the evaluation proposes a series of concrete
recommendations, amongst which are to: improve the sexual and
reproductive health of women and adolescents in natural disaster
situations and in post-disaster recovery; ensure access to
contraceptive measures, particularly condoms for the prevention of
transmission of HIV; provide post-natal care; medicine to combat
infections and post-traumatic stress; provide an adequate response to
cases of violence against women, girls and boys; include the provision
of health and legal services; and improve the security situation of
shelters to prevent cases of abuse of power by guards.

The UNFPA is currently working to rush maternal health supplies to Haiti.

Prioritize humanitarian aid to help women, children and
the elderly. They are always moved to the back of the line. If they are
moved to the back of the line, start at the back.

There are several organizations that are working to provide aid to
meet women’s specific needs in Haiti. The women’s human rights
organization Madre is,

working to send support to women’s human rights
defenders. We are hearing reports of a horror that often accompanies
disasters like this – namely, an upsurge of violence against women.
It’s critical that women human rights defenders in Haiti have the
support they need to help survivors and reach out to women who are
trying to keep themselves and their children safe in the chaos that has
gripped Port-au-Prince.

V-Day is trying to reach our sisters in
Port au Prince who run the V-Day Haiti Sorority Safe House, which
provides shelter to women survivors of violence and their children, as
well as psychological, legal and medical support. While we have not
been able to reach the staff at the Safe House, it is clear that
increased help will be needed for women survivors of violence in the
aftermath of the earthquake. Reports state that over 50,000 lives have
been lost, and that Port Au Prince has been “flattened.”

]]>http://rhrealitycheck.org/article/2010/01/17/providing-genderresponsive-aid-haiti/feed/3Fight Of Our Lives: UNICEF Uncovers The State of Maternal Mortalityhttp://rhrealitycheck.org/article/2009/01/15/fight-of-our-lives-unicef-uncovers-the-state-maternal-mortality/?utm_source=rss&utm_medium=rss&utm_campaign=fight-of-our-lives-unicef-uncovers-the-state-maternal-mortality
http://rhrealitycheck.org/article/2009/01/15/fight-of-our-lives-unicef-uncovers-the-state-maternal-mortality/#commentsThu, 15 Jan 2009 17:01:57 +0000Childbirth and pregnancy are extremely dangerous endeavors for the women of the world but most especially for women in developing nations and even more especially for teen girls in developing nations. We know this. We know that anti-choice, religious right extremists prefer to throw women and girls under the bus rather than admit to this fact. But it is the truth.

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Childbirth and pregnancy are extremely dangerous endeavors for the women of the world but most especially for women in developing nations and even more especially for teen girls in developing nations. We know this. We know that anti-choice, religious right extremists prefer to throw women and girls under the bus rather than admit to this fact. But it is the truth.

In fact, Lorraine Berry at My Left Wing writes about the extremely conservative group Concerned Women for America’s (CWFA) latest tirade on teen pregnancy, in their effort to make sure failed abstinence pledges are promoted over education and contraception. Lorraine writes:

Sometimes, all I need to know I can learn in the local graveyards. If the CWFA doesn’t believe that being pregnant is risky, that we all need to be making an effort to provide ALL women with proper pre-natal care, contraceptives, access to abortions, and assistance in leaving abusive marriages, I’d be happy to walk them through any of the dozen or so graveyards around here that have way too many graves for young women and their newborns. First wives, second wives, third wives, all buried with their husbands, who outlived his wives because childbearing killed each of them. The saddest markers, of course, are the ones where the mother and newborn are buried together.

Pregnancy and childbirth harm and kill women and are still quite dangerous for newborn babies and as far as I can tell the situation for both are not improving. UNICEF will even back me up on this. Today, the organization released its annual report and its pages reveal some shocking news:

Having a child remains one of the biggest health risks for women worldwide. Fifteen hundred women die every day while giving birth. That’s a half a million mothers every year. [emphasis mine]

“It’s really an unconscionable number of deaths. It’s a human tragedy on a massive scale,” says UNICEF Chief of Health Dr. Peter Salama.

A human tragedy on a massive scale?

Doesn’t that sound like a phrase you hear anti-choice organizations use constantly to refer to the "tragedy of abortion"? But how, and I ask this honestly, how does one justify using millions and millions of dollars and woman- and man-power to strip women and families of their right to access safe abortion care when half a million women (and their babies) are in danger of injury or death from preventable causes?

In fact, for every woman who dies from pregnancy or childbirth related causes, there are 20 who suffer pregnancy-related illness or experience severe health consequences – that’s ten million women every year who survive their pregnancies only to suffer these extreme health outcomes. And we’re talking severe people – obstetric fistula, anyone? But even fistula could be prevented and easily – easily – treated if this issue were the global priority it should be.

But it gets worse. The report focuses some of its attention on the even worse plight of adolescent pregnant girls. According to the report, every year more than 70,000 girls – young girls between the ages of 15-19 years old – die from pregnancy and child-birth related causes.

There is a strong connection between the status of girls and women in society, opportunities for education, and access to critical health care services during pregnancy and childbirth and throughout a female’s lifetime.

"If young girls are not in school, they are more vulnerable," South African Health Minister Barbara Hogan said at the launch. "It’s not just a health issue; it is about the status of young women and girls."

There are some concrete ways in which we can work towards solving the problem that involve providing necessary health services. And these services will help save the lives of both women and babies.

In addition to adequate nutrition for women, birth spacing is also central to avoiding preterm births, low birthweight in infants and neonatal deaths; studies show that birth intervals of less than 24 months significantly increase these risks. It is also imperative to secure girls’ access to proper nutrition and health care from birth through childhood and into adolescence, womanhood and their potential childbearing years.

We understand what the underlying and contributing causes to the decimation of our mothers are, so why are girls and women still, literally, fighting for their lives?

Maternal and newborn health is part of the Millennium Development Goals, a contract between the world’s governments, to tackle critical issues like poverty, HIV/AIDS, and maternal mortality. Unfortunately we have made the least progress on this goal: to reduce maternal mortality by 75% by the year 2015. In fact, it is a given that we won’t reach that goal. Why is this?

According to the UNICEF report,

That maternal health – as epitomized by the risk of death or disability from causes related to pregnancy and childbirth – has scarcely advanced in decades is the result of multiple underlying causes. The root cause may lie in women’s disadvantaged position in many countries and cultures, and in the lack of attention to, and accountability for, women’s rights.

In other words, the report says, conventions like CEDAW (the Convention on the Elimination of Discrimination Against Women) and the Convention on the Rights of the Child, both of which stipulate family planning, preventive health care, pre and post natal care and more are not being followed. It may be worth noting here that the United States is the only industrialized nation that has neglected CEDAW by not ratifiying it.

I am going to start and end this post somewhat punitively by referring once again to the larger anti-choice movement. I challenge anti-choice advocates to work with organizations like UNICEF, reflect on the knowledge that the Convention on the Rights of the Child brings us, and to use the information that family planning, prevention and education save the lives of women, girls, and newborn babies to refocus their energy on the lives of our mothers and children. In order to tackle the dire rates of maternal mortality around the world, we must prioritize the health and well-being of women & girls by doing what works – even if what works is in opposition to what the political leaders of these anti-choice organizations want to see happen.

For more on The State of the World’s Children (and Women), read the report.